Becoming an NP with little to no nursing experience?? - page 29

Hello to all!!! I have worked as a parmamedic for 20 years, have a B.A. in Economics, and I wanted to advance my career in healthcare. I was originally looking to pursue the PA route, but for... Read More

  1. by   patrick1rn
    Dude, you got some experience as a paramedic, so your not naive. Just go with the flow.
  2. by   Mahage
    Hey Blurr... Sounds to me like you have more than paid your dues and have loads of pertinent expereince. I just graduated as an associate RN and have almost finished my BSN, but am just going to work as a nurse. I was notified yesterday that I have been accepted into the RN-MSN accelerated program. Am I going....Heck yeah I am going. I will get a couple of years expereince nursing under my belt as I am completeing this program. Consider that Doctors are trained to be excellent providers without years or even any patient care experience behind them and from what I have seen as nursing students we get an awful lot of hands on expereince that a resident doesn't. They know the anatomy and maybe more patho than we do but we are drilled on assessment and intervention. My school has had no problems with their grads getting jobs though most do have more nursing expereince than I will. 2 years isn't a lot of time but it is enough to get you in an entry level NP job. I envey you your paramedic/emt expereince. You should be setting pretty. Find you an RN-MSN program, complete the RN portion, go to work and and apply for the MSN portion or maybe even a direct entry program like the one at Vanderbilt, you should be prime. Good luck, Mahage



    However, I like to think that to a certain degree I've paid my dues (I know it isn't nursing, but from a time in healthcare perspective). My friend did say that I might be considered an exception to that rule. The program is at a VERY well known school and I was told by my friend even then it wouldn't matter. I was wondering what people here thought regarding this topic. Thank you for any guidance you can provide.[/quote]
  3. by   HealthyRN
    Quote from Mahage
    Hey Blurr... Sounds to me like you have more than paid your dues and have loads of pertinent expereince. I just graduated as an associate RN and have almost finished my BSN, but am just going to work as a nurse. I was notified yesterday that I have been accepted into the RN-MSN accelerated program. Am I going....Heck yeah I am going. I will get a couple of years expereince nursing under my belt as I am completeing this program. Consider that Doctors are trained to be excellent providers without years or even any patient care experience behind them and from what I have seen as nursing students we get an awful lot of hands on expereince that a resident doesn't. They know the anatomy and maybe more patho than we do but we are drilled on assessment and intervention. My school has had no problems with their grads getting jobs though most do have more nursing expereince than I will. 2 years isn't a lot of time but it is enough to get you in an entry level NP job. I envey you your paramedic/emt expereince. You should be setting pretty. Find you an RN-MSN program, complete the RN portion, go to work and and apply for the MSN portion or maybe even a direct entry program like the one at Vanderbilt, you should be prime. Good luck, Mahage



    However, I like to think that to a certain degree I've paid my dues (I know it isn't nursing, but from a time in healthcare perspective). My friend did say that I might be considered an exception to that rule. The program is at a VERY well known school and I was told by my friend even then it wouldn't matter. I was wondering what people here thought regarding this topic. Thank you for any guidance you can provide.
    [/QUOTE]

    I think that it's a good choice to work while you are completing your MSN program. However, I will caution you that "you don't know what you don't know". I am specifically referring to your statement on how physicians don't have years of patient care experience (going into their schooling) and yet are trained to be excellent providers. They are excellent providers because of the grueling training that they undergo. Medical school and NP school are not comparable on any level.

    I used to be one of the posters on this board that would argue that it is not necessary to have nursing experience before becoming an NP. Since beginning an FNP program and gaining more nursing experience myself, I have changed my tune. I still believe that there are people who can complete direct-entry programs and become wonderful NPs. However, it would have to be a highly motivated and intelligent individual willing to devote a significant amount of time to learn information that is not taught in the program. Even then, I'm not sure that I would want to be a patient of an NP with no nursing experience.

    I am still in the first semester of my NP program and I am not certain that I will be completing the program. I am very disappointed in the content of the curriculum and this is one of the top programs in the country. The pathophysiology course, which is truely the foundation for advanced nursing practice, is little more than a review of undergrad patho. Compare that to the intense and in-depth courses that physicians receive in the first two years of medical school. The entire first two years of medical school are essentially pathophysiology. And that doesn't even begin to touch on the differences.

    I went into NP school expecting something much different, which is another reason to get some nursing experience before jumping into a program. I thought I understood the role of the NP and why a nurse would want to become an NP, but I'm not sure that I did. If someone is considering starting an NP program with little nursing experience, I would recommend a lot of shadowing. At this point, I am almost certain that I have made the wrong decision (even though I did shadowing and I was a nurse for over a year before starting my program). I think I'm going to transfer into a nursing administration and education program instead, but I have still lost time and a lot of money.
  4. by   traumaRUs
    HealthyRN - thank you for your comments. Its truly appreciated. One of the concerns that I have personally is that how do you know you want to be an NP before you ever are a nurse? ANd if somehow you just KNOW you want to be an NP, which specialty do you choose. What helped me to decide on an APN role was my nursing expereince. I'll be honest here too - I did an MSN in management and leadership, went (very briefly) into management and then went on to do a post-MSN CNS certificate.
  5. by   juan de la cruz
    Healthy RN,

    I'm sorry to hear that you are not liking your course in pathophysiology and getting disappointed about the whole program itself. You and I are in Michigan but you apparently are attending a different school than the one I trained in. Not that mine is better, but our 3 credit hour course in Advanced Pathology was held at the medical school of our university taught by medical school faculty - a team of "experts" in their fields was how they were touted as. They were good alright, but 3 credit hours was not enough to teach and absorb all the knowledge those gray-haired guys have accumulated over half of their lifetime. Needless to say, most of the information was taught so fast and went over our heads.

    But there was a light at the end of the tunnel. Things did get better after a while. I did enjoy the progression of courses that build up on the earlier concepts. As more clinical courses went by, things did make a lot more sense. I am not trying to sway your decisions to stay or leave your NP program. I am just sensing that you are making a judgment of the program you are in based on one course that you have taken. I admit that many of the things I know about my role now, I have learned on the job and through continuing education more than during NP school. But that's how an NP can become better because one has to constantly seek new and updated knowledge. NP school is just the beginning.
  6. by   Mahage
    Thanks Healthy RN for your insight. I don't mean that as NP's we would know as much as physicians, just that if they can start out treating without patient care under their belt, we should be able to learn to become NP's with minimal patient care under ours. I am sure many NP's are as good as any provider can be but I suspect they got that good far beyond NP school. I just believe that the schools that are offering direct entry programs such as Vanderbilt and accelerated programs like the onne at Southern Adventist which I am about to ender would not be risking their reputation if they were not capable of graduating competent providers. Part of it of course is my personal bias since I am a new RN, not new to health care though I have been in a supportive positionn as I have over 30 years experience in medical social work, mental health and A&D. I definately see the need to work as a nurse as I complete my program. In fact I will probably either go part time or take the least number of hours I can for full time till I get a handle on the nursing angle. I never wanted to be a nurse. I wanted to be an MD, but waited till I got to old to decide I was capable, so I looked around and decided to become a FNP. I tried for the direct entry program at Vandy but was wait listed. I decided in the mean time to become a nurse, forget direct entry! Guess what I fell in love with nursing. I hope I love it as much after spending a couple of years in the unit at our local teacching hospital! I had seriously thought about the CRNA program, but decided I am too old and don't think I can afford to fool around getting through the FNP program, so I was thrilled getting accepted into the RN-MSN program. I am almost through with all the BSN courses required for accelerated program and will get to skip about 9 hours looks like. I had BSN Patho and I love it, I look forward to advanced Patho. I dread the project or thesis. Unfortunately one or the other is required at my school. I wish it was more clinical and less research. I don't understand why they do it that way but they must have there reasons.
    Mahage
  7. by   PMFB-RN
    I don't see how anyone can say that one needs experience as a nurse to be an NP. Many if not most PA schools have no experience requirement at all. This would seem an obvious double standard to me. At least the nurse going to NP school would have received some patient care experience while in nursing school clinicals. This is far more experience than one needs to go to PA school here in Wisconsin.
  8. by   core0
    Quote from PMFB-RN
    I don't see how anyone can say that one needs experience as a nurse to be an NP. Many if not most PA schools have no experience requirement at all. This would seem an obvious double standard to me. At least the nurse going to NP school would have received some patient care experience while in nursing school clinicals. This is far more experience than one needs to go to PA school here in Wisconsin.
    Its comparing apples to oranges. Despite statements from PA leadership from the beginning roughly 1/3 of PA schools have not required medical experience. This has its roots from early research that Dr. Stead did on training medical students during WWII. While his program used experienced Navy corpsman there were immediately variation. MEDEX used experienced corpsman but shortened the didactic training and eliminated non FP rotations. It is probably the precursor to the FNP program. Other programs used the Duke model which involved extensive didactic training and extensive clinical training but used students without medical experience. Over the years the MEDEX model has largely been discarded and most programs use some variation of the Duke model and either require or do not require medical experience depending on the programs design and experience.

    If you look at Dr. Fords work, NP training from the beginning built on nursing roots to advance nursing practice. This has evolved over the years. I have not found any specific data, but DE programs are a relatively recent addition from what I read, probably paralleling the DE BSN programs for non nurses in the early 90's.

    So there is no double standard. One program is designed to train PAs according to the standards laid down by the PA profession. There is some data that PAs with no medical experience do not preform differently on the certification exam than those that who have medical experience. There is still debate within the community but it is not backed up with data.

    Final notes. As long as we are comparing apples to oranges, most PA schools that require medical experience will not accept experience as a student. They rightly acknowledge that a student is not processing the position but being a student. So an RN applying to PA school with a medical requirement would need experience as an RN. Also to the poster above, MDs do not enter practice without medical experience. To get an MD requires two years of medical experience (MS3 and MS4 years). To be licensed as a physician the MD needs at least an internship which is the equivalent to two years of full time work. Most MDs have at least three years of internship and residency before they practice independently.

    David Carpenter, PA-C
  9. by   PMFB-RN
    If you look at Dr. Fords work, NP training from the beginning built on nursing roots to advance nursing practice. This has evolved over the years. I have not found any specific data, but DE programs are a relatively recent addition from what I read, probably paralleling the DE BSN programs for non nurses in the early 90's.

    *** PA programs allow qualified people to enter directly without ever having touched a patient. I know this works and that the turn out fine PAs. So what is wrong with allowing NP students to enter directly without eve having worked as a nurse? If the program takes this into account (as a PA program must) then whats wrong with direct entry?

    So there is no double standard. One program is designed to train PAs according to the standards laid down by the PA profession. There is some data that PAs with no medical experience do not preform differently on the certification exam than those that who have medical experience. There is still debate within the community but it is not backed up with data.

    *** Is there data that indicates that NPs without nursing experience preform differently on their certification exam?


    Final notes. As long as we are comparing apples to oranges, most PA schools that require medical experience will not accept experience as a student. They rightly acknowledge that a student is not processing the position but being a student. So an RN applying to PA school with a medical requirement would need experience as an RN.

    *** I know they don't. My point is that the direct entry NP has some patient care experience totally lacking in at least some PA students at some schools.
    Those PA schools that do not require patient care experience seem to be turning out high quality PAs. Why can't the same be true for NPs?

    Also to the poster above, MDs do not enter practice without medical experience.

    *** True but they can enter medical school without any.
  10. by   core0
    Quote from pmfb-rn
    if you look at dr. fords work, np training from the beginning built on nursing roots to advance nursing practice. this has evolved over the years. i have not found any specific data, but de programs are a relatively recent addition from what i read, probably paralleling the de bsn programs for non nurses in the early 90's.

    *** pa programs allow qualified people to enter directly without ever having touched a patient. i know this works and that the turn out fine pas. so what is wrong with allowing np students to enter directly without eve having worked as a nurse? if the program takes this into account (as a pa program must) then whats wrong with direct entry?

    well for one thing nps are nps and pas are pas. if you want to be a pa you have to go to pa school. the other is that pa education is substantially different than np education in both didactic composition and clinical composition which has been discussed ad-nauseum here. the three remaining medex type programs, which in my opinion are the closest to fnp training all require large amounts of medical experience prior to pa school.

    so there is no double standard. one program is designed to train pas according to the standards laid down by the pa profession. there is some data that pas with no medical experience do not preform differently on the certification exam than those that who have medical experience. there is still debate within the community but it is not backed up with data.

    *** is there data that indicates that nps without nursing experience preform differently on their certification exam?

    unfortunately no. there is a paucity of outcomes data on np students. the only study that i am aware of supposedly showed that nps without prior nursing experience had less confidence in their clinical skills. unfortunately to my knowledge, despite being referenced at least once, it has never been published.


    final notes. as long as we are comparing apples to oranges, most pa schools that require medical experience will not accept experience as a student. they rightly acknowledge that a student is not processing the position but being a student. so an rn applying to pa school with a medical requirement would need experience as an rn.

    *** i know they don't. my point is that the direct entry np has some patient care experience totally lacking in at least some pa students at some schools.
    those pa schools that do not require patient care experience seem to be turning out high quality pas. why can't the same be true for nps?

    it is mostly a difference in educational models. i know that i am repeating this from prior posts but pa school does not build on anything. every pa student receives the same training despite their previous experience. this is to ensure a consistent product. the pharmd in my class still had to sit through pharmacology (which was taught by another pharmd). basically the model is that you get the knowledge then apply the knowledge in clinical rotations. there are some pa programs that purport to believe that pa students with medical experience make worse students since they have to be retaught things. interestingly there is outcomes data that backs this up to some extent.

    also to the poster above, mds do not enter practice without medical experience.

    *** true but they can enter medical school without any.
    true but they can't practice without experience.

    to go back to the title of the thread, you have danced around the central question when looking at nursing experience and nps. first of all there is the medical model. this is used by both pas and physicians. the didactic work is front loaded and is reinforced by the clinical training. there is no need for medical experience because you will be taught what you need to know. there are members of the pa community claim that because of the clinically focused nature of the pa education previous medical education is necessary. however, if you have read any of the arguments on this on the pa forum, you would understand that in my opinion evidence does not bear this out.

    the np model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment. over the years the entry points have changed and the programs have evolved. the de programs pose a particular question. np programs have traditionally front loaded clinical experience. in the original program it was a continuation of the nursing experience. the term advanced practice nurse comes from this concept. if this clinical experience is relevant then what are the de programs replacing with. the programs i have looked at have not substantially lengthened either the clinical or the didactic portion of the bsn or the np programs.

    now i have argued that not all experience is similar or even relevant, but you bring up a deeper issue here which i believe has also been stated before. if nursing experience in not needed for nurse practitioners then logically why is nursing needed for nurse practitioners. you can argue that it is the study of nursing is what is required via the bsn, but surely there are more efficient ways to do that then the de courses. i think this is the essence of the vitriol that you see even on this board. i would point out that there is a relevant model in the nurse midwife. you can be an rn and be a cnm or for the non rns there is the cm. both of these certifications are done by the same organization. the lack of outcomes studies only compounds the argument.

    david carpenter, pa-c
  11. by   patrick1rn
    Quote from core0
    True but they can't practice without experience.

    To go back to the title of the thread, you have danced around the central question when looking at nursing experience and NPs. First of all there is the medical model. This is used by both PAs and physicians. The didactic work is front loaded and is reinforced by the clinical training. There is no need for medical experience because you will be taught what you need to know. There are members of the PA community claim that because of the clinically focused nature of the PA education previous medical education is necessary. However, if you have read any of the arguments on this on the PA forum, you would understand that in my opinion evidence does not bear this out.

    The NP model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment. Over the years the entry points have changed and the programs have evolved. The DE programs pose a particular question. NP programs have traditionally front loaded clinical experience. In the original program it was a continuation of the nursing experience. The term advanced practice nurse comes from this concept. If this clinical experience is relevant then what are the DE programs replacing with. The programs I have looked at have not substantially lengthened either the clinical or the didactic portion of the BSN or the NP programs.

    Now I have argued that not all experience is similar or even relevant, but you bring up a deeper issue here which I believe has also been stated before. If nursing experience in not needed for nurse practitioners then logically why is nursing needed for nurse practitioners. You can argue that it is the study of nursing is what is required via the BSN, but surely there are more efficient ways to do that then the DE courses. I think this is the essence of the vitriol that you see even on this board. I would point out that there is a relevant model in the nurse midwife. You can be an RN and be a CNM or for the non RNs there is the CM. Both of these certifications are done by the same organization. The lack of outcomes studies only compounds the argument.

    David Carpenter, PA-C

    Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.
  12. by   core0
    Quote from patrick1rn
    Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.
    I'm not sure where you got nursing model in the post above. The quote was :"The NP model was originally conceived as a natural extension for experienced nurses to progress in their nursing care into the realm of diagnosis and treatment."

    The NP model at least as I describe it is different from the medical model in two respects. It integrates clinical time with didactic time (as opposed to most medical training models that sequentially teach the didactic then clinical portions). It also integrates nursing research into the curriculum.

    Also your last statement (bolded) brings up the point that I was trying to make: "If this clinical experience is relevant then what are the DE programs replacing with."

    I really don't know what it takes to make a good NP (or more specifically a good NP student). Hence this discussion.

    David Carpenter, PA-C
  13. by   CraigB-RN
    Quote from patrick1rn
    Again David, you find a way to say something about the nursing profession and the role of nurse practitioners. The didactic load in NP school is reviewed and studied and reinforced through the clinical experience. I dont know what this nursing model is that you talk about in NP school, I have never met this model. Maybe because it is taught by experienced Nurse practitioners that this supposed nursing model is what is meant. Today in clinicals, I was examining patients, getting histories, ordering labs, x rays and prescribing medicine and treatment for my patients under the watch of my eye of my preceptor NP and my other clinical site with my preceptor MD. I write a SOAP note just like any other provider, their isnt some magical nursing model that i go through to evaluate a patient. I dont utilize references by NPs alone, I utilize references made by pharmacists, MDs, NPs, DOs and even some PAs. But the point is, when you go to a NP school, one needs to know about the basics already to include understanding the clinical significance of what altered labs looks like in a patient such as a cbc, cmp, PT INR. PTT, Thyroid Levels, Lipids, Renal profiles, Pancreatic levels, Urines, Stools, Pregnancy tests, cardiac markers,PFTs well those are the basics, but having just spurted all that out, my point is NP school is taught pretty quick, it is an intense program and required RNs to have a great grasp of at least those basic labs in treating patients for various medical conditions associated .. etc. Having said that, if a NP student is not sure of something, then is the time to learn it. We have certain clinical skills that have to be performed several times during out clinicals, albeit not an exhaustive list, a decent amount of skills. So yea anyway, I feel that the NP program required a smart RN who knows those basics to make for a good NP.
    I agree with you that I've never met this nursing model either and have no idea what she looks like.

    I aactually got told that I might not have it to be an NP because, I didn't get it. 2 years later, I still have no idea, becasue I'm learning the same things as my PA wife. No differnce at all.

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